Category Archives: We’re In the News

In recent months, the national uptick in teen vaping has become less of a viral trend and more of a burgeoning public health emergency. Although e-cigarettes are nothing new, they are coming under increased scrutiny as otherwise healthy, young smokers experience a sudden rise in lung problems — and, now, even deaths. With investigations ongoing, it remains unclear exactly what vaping does to your lungs, but here’s what we know so far.

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As of Sept. 6, the CDC has cited about 450 cases across 33 states of common symptoms — including chest pain, shortness of breath, and vomiting — among people with histories of vaping. While lung scan results appear similar to pneumonia, tests show there are no infections, according to The New York Times. There is yet no specific substance or product that links all the cases, but the CDC plans to continue identifying a cause through interviews and investigation. It launched an official investigation on Aug. 1, 2019, according to the press release.

“We are committed to finding out what is making people sick,” CDC Director Robert Redfield said in another press release. “All available information is being carefully analyzed, and these initial findings are helping us narrow the focus of our investigation and get us closer to the answers needed to save lives.”

Diana Zuckerman, president of think tank the National Center for Health Research, tells Elite Daily in an interview that despite the current lack of conclusive evidence, recent episodes have been a serious warning sign about the unknown dangers of vaping. One reason it’s so difficult to identify causes, she says, is because patients report such a wide variety of vaping histories. “People who have been harmed are being asked what they were vaping and we don’t know if they’re describing it accurately, either intentionally or unintentionally,” she notes. Patients have generally in their late teens and twenties, but otherwise healthy — with similar symptoms including vomiting, fever, and fatigue, per The New York Times.

The sudden rise in health concerns may be attributable to greater awareness or more states beginning to report cases, Zuckerman said. Or, while e-cigarette companies say they have been safely selling their products for years, it may simply be that it’s taken time to notice the health effects of a relatively new technology. “It’s not like people are vaping and ending up at the hospital the next minute,” she said. “Certainly, I wouldn’t think that people are vaping more than usual in the past week.”

One potential cause may be the oil solvent ingredients in e-cigarettes, which are mixed with nicotine or marijuana to become vapor. Inhaling these oils may cause lung problems, according to The New York Times. The FDA reported that a significant number of recent samples tested for the investigation identified two specific ingredients. One is the tetrahydrocannabinol (THC) in marijuana vaping products, and the second is vitamin E acetate, one of those oil solvents. Although there is no conclusive link, the FDA urged against using THC oils in a consumer update on Sept. 6.

A report in The New England Journal of Medicine on Sept. 6, however, found that about 20% of studied patients had not ingested THC at all and had only vaped nicotine products. Further, as many vaping products do not list all their ingredients, it is hard to know what contains Vitamin E acetate. Vitamin E acetates are commonly used as dietary supplements, and although there is no proven link, it is “a good example of something that seemed absolutely safe and innocuous” but may turn out not to be when inhaled as vapor instead of swallowed, Zuckerman says.

“Years ago, we knew that we didn’t know how safe or unsafe [e-cigarettes] were, because it takes research to find that out,” Zuckerman said. “We didn’t know all the risks of cigarette smoking for decades. So, just because a product is new and hasn’t killed anybody yet doesn’t mean it’s safe.”

All this goes to say, once again, that while experts do not fully understand potentially adverse health effects, it is better safe than sorry. For now, the best option is to avoid e-cigarettes altogether — or, at the very least, to know what ingredients are in vaping products and where they’re coming from.

When Jamee Cook got breast implants at 21, she hoped to feel more confident about her body. Instead, the implants nearly ruined her life.

Just three years after her surgery, Cook, who is now 42, started having a slew of medical problems: fatigue, fevers, sinus infections, memory problems, and trouble concentrating. She felt like she constantly had the flu and could barely muster the energy to take care of her three kids. Because of her health problems, she had to quit her job as a paramedic. Four years ago, she finally saved up enough money to get her implants removed due to the complications and discovered her symptoms subsided. “I felt like I did a turnaround,” she says. She had finally gotten her life back.

Cook is not an outlier among women with breast implants. The safety of breast implants has long been a topic of debate in the medical community. After a safety scare in the 1990s, silicone implants were banned for more than a decade before the U.S. Food and Drug Administration (FDA) allowed them back on the market in 2006. But a growing body of evidence suggests that these newer breast implants aren’t as safe as this generation of women has been led to believe. The FDA requested in July that the implant manufacturer Allergan recall their textured implants, citing a link to a rare cancer called breast implant-associated anaplastic large cell lymphoma. And an online movement of thousands of women who say their implants have made them sick is calling more attention to other long-term complications.

Breast implants first came on the market in the U.S. in the 1960s. They are classified as medical devices by the FDA and an estimated 10 million women around the world have them currently. While the vast majority of those women don’t have issues, there’s increasing evidence that implants are associated with serious risks. But the available data on their safety is of poor quality, and doctors, researchers, and patients disagree about what some of the risks actually are — making it all the more difficult for women to determine them before making a decision.

The medical community has long downplayed the potential complications of implants, says Diana Zuckerman, the president of the National Center for Health Research in Washington, D.C., who has studied implants. “There are many, many plastic surgeons whose entire livelihood depends on doing breast augmentation surgery. If they were to tell every patient what all the risks are, they’d have fewer patients.”

Here’s what’s known for sure: Nearly 600 cases of breast implant-related anaplastic large cell lymphoma, a cancer of the immune system, have been reported to the FDA. As of July, 33 people died from it. Textured implants made by Allergan were linked to the cancer, and recalled globally that month. While the FDA says there’s generally a low risk of people with breast implants developing cancer from them, the agency said in a statement at the time that “we believe all individuals who are considering a breast implant of any type be informed of the risk.”

“Of the millions of women with breast implants, we know that complications occur in at least 1% of patients,” says FDA spokeswoman Stephanie Caccomo. “We believe, though, that all women should be aware of the potential risks and complications of breast implants, which are not lifetime devices.”

People who consider implants may be unaware that they are viewed as temporary devices to be removed or replaced at a later date. According to the FDA, the longer people have the implants, the higher their risk for complications. “The life of breast implants varies by person and can’t be predicted,” reads a FAQ about breast implants on the agency’s website. “That means everyone with breast implants will face additional surgeries — but no one can tell them when. And while a few people may keep their original implants for 20 to 30 years, that is not the common experience.”

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A handful of recent studies determined that there could be a connection between autoimmune symptoms and breast implants. A survey of FDA data by researchers at Houston’s MD Anderson Cancer Center last September concluded that silicone implants are associated with higher rates of autoimmune diseases like Sjögren syndrome, scleroderma, and rheumatoid arthritis. Meanwhile, an Israeli study from December found that women with silicone implants had a 22% increase in the risk of having an autoimmune or rheumatic disorder.

The FDA pushed back on the MD Anderson study, saying in a statement at the time that agency officials “respectfully disagree” with the authors’ conclusions. But the renewed scrutiny, along with concerns about the link to cancer, prompted the agency to hold a two-day summit on breast implant safety in March. Doctors, researchers, manufacturers, and patient advocates — including Cook — spoke.

In May, the FDA said in a statement that the information gathered at the meeting “makes clear there is an opportunity to do more to protect women considering breast implants.” Officials said they would take better steps to communicate the risks of cancer and other systemic symptoms, and are considering “changes to the labeling of breast implants, which could include a boxed warning and a patient decision checklist to help women consider the benefits and risks of breast implants,” according to Caccomo.

The groundswell of patient advocacy has also started to move the needle in the medical community. “You can’t necessarily prove a link per se, but it’s real,” says Glasberg, the New York City plastic surgeon. “And it’s especially real for those patients.”

Doctors like to say that breast implants are the most studied medical device in history, and they’re not necessarily wrong. But critics have poked holes in the data that exists. The National Center for Health Research’s Zuckerman says that many studies of breast implants used to determine safety had high dropout rates and didn’t track patients for more than a few years, a serious flaw given that most complications crop up later. They were also too small to detect rare complications. Other studies only tracked women who had a diagnosed illness and were hospitalized for it, which would cut out many of the women dealing with the symptoms of breast implant illness. Most of the studies are also paid for by implant manufacturers or plastic surgery associations, who have a stake in data that points to good outcomes.

In 2006, when the FDA reintroduced silicone breast implants, the agency required that manufacturers conduct 10-year studies of 40,000 women. But those studies were never completed. In the breast augmentation section of the Allergan study, 40% of the women dropped out after just two years. Meanwhile, Mentor, another manufacturer, lost 80% of its augmentation participants after three years.

Part of the reason so many women dropped out of the study is because there was no incentive for them to participate. Allergan paid women $20 per year to fill out the survey. For filling out a 27-page long annual survey, Mentor offered no payment. In March, the FDA issued warning letters to Mentor and another implant manufacturer, Sienna, castigating them for failing to comply with the requirements the FDA gave for approval. The agency threatened to rescind its approvals of the products.

The problem with the unreliability of the data on breast implant risks, experts say, is that women do not have the right tools to assess for themselves how safe the procedure is. “I can’t believe that after all these years,” says Zuckerman, “we still don’t know what percentage of women with breast implants are going to have problems, and what percentage are going to have which [kinds of] problems.”

Breast implants have long posed a safety concern. After they were first put on the market in the U.S. in the 1960s, some women reported that their implants were leaking silicone into their bodies. They also complained of chronic illnesses similar to the symptoms of breast implant illness today. In 1992, the FDA banned silicone implants, with the exception of clinical trials.

In 1999, a study from the Institute of Medicine determined that there was no evidence linking silicone implants to more serious complications like autoimmune disorders and cancer. When an FDA panel voted to once again approve silicone devices, the panel’s chairman publicly opposed the decision, writing in a dissent letter that “to approve this device poses threats to women that are clearly unknown.”

The long-term complications posed by breast implants today are rare. “Hundreds of thousands of patients each year opt for breast implants — more than 400,000 just in 2018 in the United States alone,” says Colleen McCarthy, a plastic surgeon at the Memorial Sloan-Kettering Cancer Center in New York City. She is the principal investigator for the PROFILE Registry, which collects data on anaplastic large cell lymphoma and breast implants. “The overwhelming majority of these women report no adverse effects.” For his part, Glasberg says breast implants are safe enough that he would put them in one of his family members.

What is clear is that the medical community can do more to study the risks — and communicate them to people considering the procedure. “If [getting breast implants] is what you choose to do, then so be it,” says Cook. “But you need to be armed with the proper information before you make that decision.”

Vaping, even temporarily, can affect the blood vessels in healthy people — even if the vape pod does not contain nicotine, according to a new study published in the journal Radiology this week.

Researchers from the University of Pennsylvania School of Medicine studied 31 volunteers, all of whom were healthy, non-smoking adults with an average age of about 24 years old.

The participants were monitored as they each took 16 three-second inhalations from a disposable e-cigarette. The researchers used an ePuffer with flavored e-cigarette liquid but no nicotine in it. A research coordinator made sure sure the participants did not cough or swallow the vapor.

The researchers then conducted MRI scans on the participants and found a reduction in blood flow in the femoral artery in their legs. This change occurred after just one vaping experience.

The findings suggest vaping impaired function of the endothelium, or inner lining of blood vessels, a press release on the study explained.

“These products are advertised as not harmful, and many e-cigarette users are convinced that they are just inhaling water vapor,” Alessandra Caporale, Ph.D., a post-doctoral researcher and lead author of the study, said in a statement. “But the solvents, flavorings and additives in the liquid base, after vaporization, expose users to multiple insults to the respiratory tract and blood vessels.”

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“Lung damage is what we’re most focused on right now, but there’s so much more going on,” Dr. Diana Zuckerman, president of the National Center for Health Research, recently told CBS News. “There are chemicals in Juul and e-cigs and we’re not exactly sure what the impact is going to be because we haven’t seen it before.”

A study published in the journal Pediatrics last year found a number of different toxic chemicals in e-cigarettes, including one linked to several types of cancer. Some of the chemicals turned up even when teens used non-nicotine products like fruit-flavored vapes.

In Wisconsin, at least a dozen people have recently been hospitalized and treated for severe lung damage. The first cases were reported last month, and the number has been growing. All of these patients are young — between their teenage years and 30s — and all of them appear to have been harmed by vaping.

The hospitalization of at least a dozen young people raises the question: How have e-cigarettes caused so much damage, when they haven’t even been around for that long?

“It’s mind-boggling,” Dr. Diana Zuckerman, president of the National Center for Health Research, told CBS News. “The vast majority of people who smoke started as children or as young teens, and yet you don’t hear about people getting lung cancer until their 40s, 50s, 60s,” she said. “Think about that compared to what’s happening to these kids now. I’ve never heard of a smoker ending up in the hospital in their teens.”

Zuckerman pointed to one specific case: a college freshman from Florida whose lung collapsed. In an interview with The Daily Mail, the teen admitted to vaping about one JUUL pod every two days for a year.

“Really, a collapsed lung on an 18-year-old after one year? That’s mind-boggling,” Zuckerman said. “He didn’t have the symptoms that might have warned him that something was wrong — until something was really terribly wrong.”

The big problem she sees with Juul and other e-cigarettes and vapes: “We don’t know yet what the symptoms might be,” Zuckerman said.

It took doctors years to fully understand all of the risks associated with smoking cigarettes, including cancer, Zuckerman said. When it comes to vaping, it is too early on for doctors to know all the potential long-term health consequences. However, there is growing evidence of short-term risks and lung damage, according to Zuckerman.

“Lung damage is what we’re most focused on right now, but there’s so much more going on,” she said. “There are chemicals in Juul and e-cigs and we’re not exactly sure what the impact is going to be because we haven’t seen it before.”

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While there are many unanswered questions about vaping that may be revealed over time, one thing is starting to become clear to Zuckerman: “It seems some kids are having very measurable damage in a very short period of time than what we’ve seen from [cigarette] smoke.”

Juul’s popularity with teens is a particular concern because the rash of lung problems appears to be affecting young people more than any other age group. “The same amount of vaping for a child that weighs, say, 100 pounds, is a bigger issue than for somebody who weighs 200 pounds,” Zuckerman said.

In 2014, Pfizer paid for a study of its rheumatoid arthritis drug Xeljanz — one authored by 12 experts, all with financial ties to the company. Xeljanz came out on top.

The twist: It was not compared to the treatment experts consider the most effective.

All three efforts were part of a massive drug company push to boost the sale of expensive, immune-suppressing drugs to treat autoimmune conditions such as psoriasis and rheumatoid arthritis.

The drugs, many of which are biological medicines, called biologics, were introduced two decades ago and have hit $45 billion in sales, despite escalating prices and mounting reports of serious side effects.

“There are a lot of different playbooks on drugs,” said Diana Zuckerman, president of the Washington, D.C.-based National Center for Health Research, a public health advocacy group. “The industry knows how to sell a product.”

AbbVie’s nurse program is the focus of an insurance fraud lawsuit filed last year by the California Department of Insurance. It alleges the company paid kickbacks to doctors to prescribe the drug and sent the nurses into homes “to keep patients on a dangerous drug at any cost.”

The lawsuit, which claims more than $1.2 billion in insurance fraud, alleges the nurses were trained to hide Humira’s serious cancer and infection risks — allegations AbbVie denies.

Upbeat TV commercials and magazine ads that tout the benefits of the drugs.

Treatment guidelines that call for doctors to prescribe them — written by doctors with financial ties to drug companies.

Favorable studies underwritten by drug companies — often conducted by researchers who double as speakers and consultants to the companies.

Biologic drugs are cultured from animal cells and introduced by injection or IV.

The drugs are often effective and can lead to significant improvement in symptoms, even remission. But they also leave patients susceptible to a growing number of infections and other serious side effects.

While the FDA database has limitations, including a lack of verification of the reports and the possibility that other drugs could also have been used, it is the largest publicly available data set of reactions associated with prescription drugs.

If anything, experts say, it undercounts the potentially dangerous incidents.

Zuckerman, the head of the public health advocacy group, said part of the drug company strategy is to get the FDA to approve more and more products — or to get existing drugs approved to treat more and more conditions.

That creates a confused marketplace.

“The doctors are left with 20 different products and no idea which one is best for which patient,” she said.

Rising competition, rising costs

Led by top-selling Humira, biologic drugs have become some of the biggest moneymakers for the U.S. pharmaceutical industry.

Prescriptions for them were on pace to exceed more than 6 million in 2018, up from about 4 million in 2013, according to data from the pharmaceutical market research firm IQVIA. That represents a 50% increase.

Humira prescriptions were set to top 3 million, an increase of more than 60%.

Meanwhile, biologic drugs were expected to tally $45 billion in sales, with Humira on pace to hit $18 billion alone — an increase of more than 150% since 2013.

The list price on the drugs can exceed $40,000 a year, though rebates and discounts can reduce the amount paid by insurance companies and individuals.

There are now more than 20 biologic drugs on the market, in addition to other, traditional treatments for the conditions.

Before 2009, they were the only such drugs approved to treat rheumatoid arthritis.

In the years that followed, the FDA approved three more drugs — increasing competition. The study authors expected costs would still rise 34% from 2009 to 2016, due to inflation and other factors. Instead, costs went up 144%.

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California alleges insurance fraud

In September 2018, the California insurance commissioner’s office laid out its case of financial impropriety against AbbVie, providing a window into the push to boost sales of Humira.

A similar lawsuit was filed in federal court in Illinois.

That lawsuit alleges AbbVie officials “bragged at national sales meetings about how the Ambassador Program resurrected the otherwise plateauing sales of Humira and attributed a sharp and specific rise in sales directly to the Ambassador Program.”

Both cases are pending. AbbVie denies wrongdoing.

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The California lawsuit alleges the program began as a pilot effort in 2012, developed a presence in California in 2013 and soon became “wildly successful in this state and others.”

Through the program, doctors allegedly got kickbacks in the form of cash, meals, drinks, gifts, trips, even patient referrals.

One court document indicates the national program reached 179,000 patients.

“Kickbacks and more sophisticated schemes, like those alleged in the AbbVie case, are significant drivers in the out-of-control cost of prescription drugs that harm consumers,” California Insurance Commissioner Ricardo Lara said in a statement to the Journal Sentinel.

His office estimates private insurers in California alone paid out $1.2 billion in Humira claims from 2013 to 2018, making it potentially the largest insurance fraud case in the department’s history.

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Major marketing push

In 2018, Humira topped all drugs for ad spending, at $483 million, according to data from the firm Kantar Media, which tracks cross-media ad spending.

Xeljanz, a non-biologic that competes in the same market, was third at $256 million. Cosentyx, a biologic, was eighth at $180 million.

The totals include all ad spending, aside from social media, but TV commercials are clearly at the center of marketing efforts — particularly on cable news networks.

During a five-day span in mid-March, a total of 21 commercials for autoimmune system drugs — most of them biologics — were aired during cable news shows on CNN, Fox and MSNBC between 6 and 9 p.m., according to a Journal Sentinel analysis.

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Rita Redberg, editor of the journal JAMA Internal Medicine, said she is struck by how many of the drugs are advertised on TV.

“It is clear (the drugs) are not selling on the merits alone, otherwise they wouldn’t need all the advertising,” said Redberg, a professor of medicine at the University of California, San Francisco.

Drug companies and treatment guidelines

Doctors frequently turn to treatment guidelines when it comes to determining how to care for patients. The guidelines, which serve as national standards for treating various diseases, often are used by front-line doctors who see patients and write prescriptions.

They are frequently issued by medical societies and related groups.

Where do the groups get their money?

Often from companies marketing the drugs.

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Consider the 2011 guidelines for treating psoriasis and psoriatic arthritis issued by the American Academy of Dermatology.

Those guidelines said that if a person with a milder case of the disease has an important upcoming event, such as a wedding or graduation, it is OK to use biologic and other drugs.

However, the FDA has only approved biologic drugs for more serious cases, what is known as moderate to severe psoriasis.

The guideline-writing committee was made up of 15 experts, 12 of whom — including the chairman — had financial ties to companies that make biologic drugs.

At the time the guidelines were issued, committee chairman Alan Menter disclosed he received money from three companies that make biologic drugs for psoriasis, but did not list the amounts.

A check of the federal government’s Open Payments database showed that in 2013 he received about $90,000 from those companies. He continued to work with the companies, receiving more than $300,000 between 2014 and 2017.

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Meanwhile, the American Academy of Dermatology has received millions of dollars in funding in recent years from companies that manufacture biologic drugs, based on giving levels the group lists on its website and other records. AbbVie, the maker of Humira, alone gave more than $2 million in grants and donations to the academy between 2013 and 2017.

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Less expensive option not recommended

Financial conflicts were also at play in 2015 treatment guidelines for rheumatoid arthritis from the American College of Rheumatology.

Rheumatoid arthritis causes inflammation, leading to swelling, pain, stiffness and potential damage to the joints. The condition affects more than 1 million Americans.

Experts generally agree that the best first-line treatment for the condition is the generic drug methotrexate, which is normally is taken by mouth. If that fails, a biologic can be added.

But there are other options, such as adding two generic and less expensive non-biologic drugs — what is known as “triple therapy.” A 2013 paper in the New England Journal of Medicine showed that approach to be just as effective as adding the biologic Enbrel.

The effectiveness may be equal, but there is a dramatic difference in cost.

“Triple therapy” costs less than $4,000 a year, while taking a biologic drug costs about $43,000, according to an analysis provided to the Journal Sentinel by Alvaro San-Juan-Rodriguez, a research fellow at the University of Pittsburgh School of Pharmacy.

All 12 authors had financial ties to the company, including eight who were employed by Pfizer, which funded the study.

What’s more, the study compared Xeljanz to the drug methotrexate alone — not the more effective treatment of methotrexate plus a low-dose steroid. The study concluded Xeljanz was better.

Other studies of rheumatoid arthritis drugs have taken the same approach.

Pfizer spokesman Steven Danehy noted the study authors are recognized experts in the field and work with many pharmaceutical companies. He added: “Further, the New England Journal of Medicine works with an editorial team that employs rigorous editorial, peer and statistical processes to evaluate manuscripts for scientific accuracy.”

Critics question why Xeljanz was tested against a “second-best treatment” — and whether patients in the trial knew what they were getting.

“Comparing the new treatment to a treatment that we already know is not good enough proves nothing,” said John Kirwan, an emeritus professor of rheumatic diseases at the University of Bristol in the U.K.

“You can’t help thinking that the company designed their study this way just to make their new treatment look good.”

Consumers should always read drug labels to make sure they are taking a medication correctly and safely as well as to learn about possible side effects. Unfortunately, these labels can be challenging for the average person to digest.

If you struggle to make sense of the information on your drug labels, you are not alone.

“Several studies have shown that patients often have difficulty in reading and understanding medication labels, which may lead to medication errors such as taking the wrong medication or the wrong dose,” said Mireille Hobeika, who received her doctorate in pharmacy from the University of Saint Joseph in West Hartford, Connecticut.

Understanding drug labels is even more important for people with chronic illnesses and seniors. They have the greatest risk of medication errors or interactions because they tend to take multiple medications.

There are two kinds of drug labels: over-the counter drug labels — also called Drug Facts — and prescription drug labels, which include many pages of safety information, such as pharmacy information sheets, medication guides and prescribing information.

Before you start taking a new medication, review the drug label with your doctor and pharmacist and let them know of any health conditions you have and any medications and supplements you take.[…] Diana Zuckerman, president of the National Center for Health Research, recommends patients consider the following questions and tips when reading clinical trial data on drug labels.

Were patients in the study like you in terms of age, sex and race? Look for at least 30 patients like you in the study. It might not provide you the most relevant data if people in the study aren’t similar enough to you.

Were patients in the study like you in terms of medical diagnosis? For example, if it’s a cancer drug, did the study involve people with your type of cancer? The same goes for drugs that treat other diseases. Data might be less relevant to you if you are not represented by patients in the study.

Is the drug tested in people who failed at other treatments? The FDA approves some higher risk drugs for people with no other treatment options.

Medication Guides

If a drug has an FDA-approved medication guide, pharmacists are supposed to give it to patients with their prescription, but this doesn’t always happen. And not all drugs have them.

The FDA requires manufacturers to write medication guides in easy-to-understand language for patients. You can find these medication guides on the drug manufacturer’s website or on DailyMed.

The blood thinner Coumadin, also known under the generic name warfarin, has a medication guide. Similar to the Drug Facts on an OTC label, the medication guide tells patients the most important prescription drug information in simple language.

INFORMATION IN A MEDICATION GUIDE

What is the most important information I should know about the drug? The most serious risks, side effects and symptoms you should look for are detailed here.

What is the drug? Here you can find the condition or symptoms the drug treats.

Who should not take the drug? This section describes diseases or health conditions that may worsen with use of the drug. It also addresses people who may be allergic to the drug.

Before taking the drug. If you have diseases or health conditions listed in this section, talk to your doctor before taking the medication.

How should I take the drug? This section explains the special instructions on how to take the drug. It reminds people to take the drug only as directed by their doctor.

What are the possible side effects of the drug? This section includes side effects information and brief explanations about each side effect. Sometimes it includes information on tests your provider may run or symptoms to watch for.

How should I store the drug? Information on how to store the drug is included here. Some drugs are sensitive to heat or cold and some may need refrigeration.

What are the ingredients in the drug? Check this section for the active and inactive ingredients. Tell your provider if you are allergic to any ingredients in the drug.

Is Side Effect Information Always Accurate?

Side effect information on drug labels usually comes from clinical trial data collected before a manufacturer sells the drug. Sometimes the label will get an update based on side effect reports the FDA receives after the drug has been on the market. This information is called postmarketing data.

“If side effects are known, they should always be included on the label, but some side effects aren’t known until years after a product goes on the market,” Zuckerman said.

“Back when I took Levaquin in 2006, there were no black box warnings on fluoroquinolones,” said Brummert, who suffered multiple ruptured tendons after taking the antibiotic. “The first warning came in 2008 for tendon ruptures, and that black box only stated that people over 60 were at risk. Adverse reactions I have suffered that are still not included in the warnings are autonomic and central nervous system dysfunction and neurodegenerative disorders.”

Brummert said she discovered the FDA had admitted to these side effects in a hidden document obtained through a Freedom of Information Act request.

What Should You Do If You Don’t Understand a Label?

If you have tried reading a drug label and don’t understand it, don’t be afraid to ask for help. Your health care provider and pharmacist are there to assist you.

“Before leaving the doctors’ office, patients should make sure they are well informed about the name of the drug and why they are taking it, the medical conditions this drug treats, how many times per day should they take it, how long will it take this drug to work, when should they stop taking it, are there any side effects that they should know about and any situations where they should not be taking the drug,” Hobeika said.

If you leave your health care provider’s office without the information you need to take your medicine safely and effectively, the pharmacy from where you pick up your medication can help. Your pharmacist can answer questions about OTC and prescription medications.Hobeika recommends having all prescriptions filled at the same pharmacy, so the pharmacist has a record of them. She also suggests doing the following before you leave the pharmacy:

Check the label to make sure your name is on it. If it isn’t, talk to the pharmacist.

Check the label to make sure you can read and understand the name of the medicine, directions and colored warning stickers on the package. If the letters are too small to read, ask your pharmacist to print it in a larger type.

Are the directions on the package the same as those you and your provider discussed? If not, tell the pharmacist.

Ask if there are special instructions on how to store the medicine. Should it be kept in the refrigerator or a dry place?

Ask if there is anything you shouldn’t eat or drink while taking the medicine.

Ask if it’s safe to take the drug with other prescriptions or OTC medicines you’re taking.

Candyce Kirbyson wanted a bit more. At 105 pounds, she had A-cup breasts. So at 32, the Seattle-area mom decided to get implants. But she got a lot more. A laundry list of ailments, in fact. Hives and muscle weakness. Numbness and tingling in her arms and legs. Insomnia and chronic sinusitis. At various points in Kirbyson’s 14-year slog through doctor’s offices, MRIs, and emergency-room visits, it was suggested (among many other potential diagnoses) that she had “mold toxicity,” sometimes known as “sick-building syndrome.”

Kirbyson wondered if it had to do with her new office. “I was on and off antibiotics that would work for a while, and then my hives and inflammation would come back,” she says. “I sometimes felt like I was getting early Alzheimer’s, like my brain wasn’t working. I tried integrative medicine, functional medicine, ENTs. Nobody could figure out what was going on, and doctors said it was all in my head. I felt like I was dying.”

Never once did Kirbyson suspect the implants as the source of her sickness since she didn’t have pain in her breasts and not one doctor had ever raised the possibility.

Then late last year, she read an article that led her to a Facebook group that described similar symptoms. “I started crying my eyes out, because everything I was reading was what had happened to me,” she says. Kirbyson consulted a local plastic surgeon who was mentioned in the group and had her implants removed in January.

Slowly, her symptoms are diminishing. “My energy is back, my brain fog is lifting, the tingling and hives are happening less,” she says. “I’m 500 percent sure that my whole system broke after I got implants.”

An alarming conclusion, particularly since breast augmentation is the most popular plastic surgery. There were almost 314,000 procedures in the U.S. in 2018, up 4 percent from the previous year. In a 2011 report, the Food and Drug Administration estimated that between 5 and 10 million women worldwide have breast implants. Admittedly, fears about potential dangers have surrounded implants since their inception in 1961. But past concerns were that they would rupture and leak.

The new fear factor: Could simply letting these things exist in your body be ruinous? Claims like Kirbyson’s — that breast implants have triggered inexplicable chronic illness — are growing, and new reports show a direct line from implants to a rare lymphoma. In March, the FDA held a public advisory committee meeting on breast implants to discuss these issues. Sides were taken, and tensions ran high.

One of the speakers, Diana Zuckerman, the president of the National Center for Health Research, who has been a voice in the debate for decades, says: “I was struck by how often the answer to a question was ‘We don’t know.’ We don’t know which implants are better or worse, or how often people get sick. Women deserve to know what their odds are of getting sick because of their breast implants, and we can’t answer that question.”

Doctors and the FDA concede that there is still much to learn, says Grant Stevens, the president of the American Society for Aesthetic Plastic Surgery (ASAPS) and a clinical professor of plastic surgery at the Keck School of Medicine of USC. But after 35 years of performing breast implants on more than 10,000 patients, he’s convinced that the vast majority have few problems with the devices.

Women suffering from what they call breast implant illness (BII) beg to differ. Though not a disease, BII has recently gained credibility. So much so that the FDA has incorporated the patient-coined term into its website among cautions about implants, citing “systemic symptoms” as one potential risk, although “what causes them are poorly understood.”

In the run-up to its March meeting, the FDA listed examples of the top reported BII markers: fatigue, brain fog, rash, joint pain, and memory loss (amid an exhaustive 87-item list of other possible issues, including “ear ringing” and “throat-clearing”).

“BII is not a diagnosis,” says Stevens. “It’s a collection of symptoms — about 22 of which I have myself at any given time. [But] I’ve looked into the eyes of women who say they’re going through it, and I know they’re not making it up. They’ve seen a bunch of doctors; they’re frustrated; they’re scared.”

There have been no formal studies on BII to mollify those fears. (The first of its kind is starting now, funded by the Aesthetic Surgery Education and Research Foundation, according to Stevens.) It’s difficult to track symptoms that are so subjective and wide-ranging, and Laurie A. Casas, the former president of ASAPS’s Aesthetic Surgery Education and Research Foundation and a clinical professor of plastic surgery at the University of Chicago Medicine, says many manufacturers have “had trouble getting” follow-up reports on patients who use their implants — an FDA requirement.

In March, the agency issued warning letters to two companies, Mentor and Sientra, for falling far short. In a statement to Allure, Mentor admits they “continue to encounter challenges,” due to the low percentage of U.S. patients who use their textured implants. Sientra told us that many of its patients have family and work obligations that preclude them from follow-ups, but says it’s committed to helping bridge that gap by compensating patients and doctors.

“I think some companies did a lousy job,” says New Jersey–based plastic surgeon Caroline Glicksman. “You tend not to hear from patients who are doing fine. These manufacturers should incentivize women who take time and spend money to show up for follow-ups every year.” One company that did that, Ideal, was able to track nearly 95 percent of its patients for five years by offering a balloon payment at the end of the study, potentially granting each woman $5,000 to $8,000.

The recent establishment of several breast implant “registries” could also help to assess long-term safety. “Ideally, we want to track every implant in every patient over the lifetime of the implant,” says Casas. “These studies should have a control group of women of the same age that do not have implants. That way we can understand the incidence of these symptoms in women of the same age who have and do not have implants.”

That raises the question: Could it be that breast implants aren’t for everyone? Many doctors are intrigued by the potential of using genetic tests to determine whether someone might have inflammatory or allergic “markers” that would indicate they’re a bad fit for the devices, says Casas. That’s a possibility the FDA is now entertaining, saying in a statement: “A growing body of evidence suggests that a small number of patients may have biological responses to certain types of materials in implantable or insertable devices. They develop inflammatory reactions and tissue changes, causing pain and other symptoms that may interfere with their quality of life.”

That small number of patients is radicalized. The Breast Implant Illness and Healing Facebook group, for one, has grown from a few hundred members to more than 70,000 in the past three years. Its message — your breast implants are making you sick — is powerful. But that power can be a double-edged sword, says Nashville-based plastic surgeon Melinda Haws. “Many women have turned to social media for support and information when their doctors were unsympathetic,” she says. “Unfortunately, the support groups, in many cases, have become more trusted than the plastic surgeons. If I’ve got a pain in my knee, I can search the Internet for the cause. But I still have to see an orthopedic surgeon.”

BII’s symptoms can make many patients feel helpless and unnecessarily guilty, since it’s an elective surgery. “Many women have described to me the negative impacts on their family and their jobs that they believe have come from this procedure,” says Haws, adding that such worries can compound and worsen insomnia and anxiety.

For patients like Kirbyson, advice from the BII group was transformational. However, for Celeste Greene*, it presented a red herring. Greene got her first implants at age 21. They were saline and lasted six good years, until they began to feel hard and she traded them for silicone implants. She soon developed some symptoms similar to Kirbyson’s, went through full-panel tests with no conclusive diagnosis, and three years later, found solace and enlightenment in the same Facebook group.

Within about nine months of finding the group, she had her implants removed. As she recovered, Greene felt markedly better. Fast-forward a few months, and all of her symptoms returned. It took another year, a divorce, and finding out that her estrogen was abnormally low (“My endocrinologist said it was like that of a 60-year-old woman!”) for Greene, now 36, to get a complete picture. She is now positive that job stress, studying for board exams to keep that job, an abusive marriage, and hormone irregularities were collectively the “perfect storm” that caused her malaise. “It was an expensive lesson.”

The F.D.A. decision, based on an increasing number of cases and deaths from the implant-associated cancer, lags far behind action in Europe, where the Allergan devices were effectively banned late last year.

F.D.A. officials said they were continuing to monitor the incidence of lymphoma linked to other types of implants and would take action against them if needed.

They also said they were considering changes to the labeling of breast implants, like adding a black-box warning to draw attention to the risks, and requiring doctors and patients considering the surgery to go over a checklist to help women understand the benefits and risks of the devices.

The contents of the implant, silicone or saline, are not a factor in the lymphoma. The covering or shell of the implant, which can be either smooth or textured, is the key. Textured implants, which have a slightly roughened surface that adheres to tissue and helps hold the device in place, have been singled out as the cause of the lymphoma.

Why the texturing leads to cancer in some patients is not known. Some people may be genetically predisposed to have an inflammatory reaction to the texturing that can gradually lead to cancer, Dr. Clemens, the plastic surgeon, said. Some researchers also suspect that bacteria trapped in crevices in the roughened surface might somehow lead to the lymphoma.

Although several companies make textured implants, a great majority of the lymphoma cases have occurred in women with the Allergan products.

Allergan’s textured implants account for only about 5 percent of the implants used in the United States, but have been much more common in Europe, where they have already been recalled by many countries. Worldwide, 38 countries have banned textured implants, Dr. Clemens said.

Allergan said on Wednesday that it was halting sales of the textured implants worldwide.

“When women decide to get breast implants for reconstruction after mastectomy or for breast augmentation, they should not be putting their lives at risk for lymphoma,” said Diana Zuckerman, president of the National Center for Health Research, who has studied implants.

She added that the recall would reduce the risk but not eliminate it, because some women with other types of implants also had the lymphoma.

Allergan will recall its Biocell textured breast implants worldwide after United States health authorities requested that it remove them from the market due to their association with a rare cancer of the immune system.

The announcement, which reflects the most sweeping recognition to date of the serious health risks associated with breast implants, comes after the U.S. Food and Drug Administration obtained new data showing that Allergan implants were linked to most known cases of the cancer, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

“Once the evidence indicated that a specific manufacturer’s product appeared to be directly linked to significant patient harm, including death, the FDA took action to alert the firm to new evidence indicating a recall is warranted to protect women’s health,” said FDA Principal Deputy Commissioner Amy Abernethy, in a statement issued by the agency.

The company said the recalled implants, both saline and silicone, would no longer be distributed or sold in any market where they are currently available.

[…]

President of the National Center for Health Research Diana Zuckerman, who has called for stricter oversight of breast implants, said Allergan’s recall was a step in the right direction but did not eliminate the risks of BIA-ALCL.

“When women decide to get breast implants for reconstruction after mastectomy or for breast augmentation, they should not be putting their lives at risk for lymphoma,” Zuckerman said.

“This recall will reduce that risk but it won’t eliminate it, because the FDA has stated that not all women with BIA-ALCL had these specific types of implants.”

In its press conference, the FDA said that it was considering additional measures to protect patient safety.

The agency said it would soon announce updated labeling standards for breast implants, and that these might include a black box safety warning, which is reserved for products that pose the most serious health risks.

The FDA also said it might require a patient checklist, a document that briefly states the key health risks from breast implants which patients would sign before undergoing surgery. The agency is not recommending that women who currently have Allergan Biocell implants get their implants removed, unless they experience signs or symptoms of BIA-ALCL.

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